Oral Pathology and Oral Medicine
This domain tests recognition and safe management of oral mucosal, odontogenic, salivary and potentially malignant disease. The exam favours clinical reasoning: risk factors, duration, site, appearance, and whether biopsy or referral is required.
Clinical approach
- Take a focused history: onset, duration, pain, recurrence, tobacco, areca nut, alcohol, trauma, medication and systemic disease.
- Examine site, size, colour, induration, fixation and regional lymph nodes. A non-healing ulcer over two to three weeks, induration or unexplained bleeding needs urgent biopsy or referral.
Common entities
- Leukoplakia is a clinical white patch not attributable to another disease; erythroplakia is a red patch with higher malignant potential. Both require biopsy when persistent.
- Oral lichen planus often shows bilateral reticular striae, usually on buccal mucosa; ulcerative or erosive areas may need biopsy to exclude dysplasia.
- Pseudomembranous candidiasis wipes off; angular cheilitis and denture stomatitis are common variants. Aphthous ulcers are recurrent, painful and usually non-keratinised.
- Mucocele affects the lower lip; ameloblastoma favours the posterior mandible; odontoma is a mixed odontogenic hamartoma. Squamous cell carcinoma is the most common oral malignancy, especially lateral tongue and floor of mouth.
Worked example
A 55-year-old smoker has a 2 cm indurated ulcer on the lateral tongue for six weeks, with otalgia. Reasoning: duration, induration, site and referred ear pain are red flags for squamous cell carcinoma. The correct step is incisional biopsy and urgent referral, not a trial of antifungal or steroid treatment.
Traps that cost marks
Leukoplakia is a clinical diagnosis, not a histological one. Not every white patch is candidiasis. Do not biopsy a vascular lesion without imaging. Do not reassure because the lesion is painless; oral cancer is often painless early. Recurrent aphthous ulcers are not treated with antibiotics.